But it is feared patients could be using A&E, because they are unaware of, or having difficulty accessing, alternative forms of treat-ment.

Clinical director of A&E at the Royal, Peter Burdett-Smith, said: "They've tapped into a large pool of patients with relatively minor ill-ness, who previously didn't bother to access any medical attention because it was difficult to get access to a GP.

"Walk-in centres are very busy, but they are not the same patients normally going to emergency departments, it's the type that would normally go to a GP.

"It hasn't actually made a difference to our workload."

Management at the Royal is keen to point out the views of the clinical director are not necessarily the views of the trust.

Brian Goodinson, for the trust, said they had been working closely with the PCTs to strengthen and improve services out-of-hours.

A spokeswoman for Liverpool's three primary care trusts said visits to walk-in centres had increased and they were working closely with the Royal to ensure minor injuries are dealt with promptly.